Fill in this information to identify your case:

United States Bankruptcy Court for the:

NORTHERN DISTRICT OF ILLINOIS

Case number (if known) Chapter you are filing under:

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13  Check if this an

amended filing

Official Form 101

Voluntary Petition for Individuals Filing for Bankruptcy 12/15

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a joint

case—and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,” the answer

would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to distinguish

between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in

all of the forms.

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If

more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer

every question.

Part 1: Identify Yourself

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

1. Your full name

Write the name that is on

your government-issued

picture identification (for

example, your driver's

license or passport).

Bring your picture

identification to your

meeting with the trustee.

Shawni

First name First name

S.

Middle name Middle name

Moshiri

Last name and Suffix (Sr., Jr., II, III) Last name and Suffix (Sr., Jr., II, III)

2. All other names you have

used in the last 8 years

Include your married or

maiden names.

Shanin Moshiri

Shawni Mo

Shawni Moshiri

Shawni F. Moshiri

S Moshiri

Shawni Moshin

Shawni Moshir

Shahin Moshiri

Shan Moshiri

Shani Moshiri

Shanni Moshirir

Shan-ni Moshiri

Shawane Moshiri

Shawne Moshiri

Shawni DPM Moshiri

Shawni G. Moshiri

Shawni S. Moshiri

Shawni S DPM Moshiri

Shawni Mishiri

Shawni M. Moshiri

Shahin M. Moshiri

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1

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Debtor 1 Shawni S. Moshiri Case number (if known)

Shanin N. Moshiri

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx-xx-1550

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2

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Debtor 1 Shawni S. Moshiri Case number (if known)

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

4. Any business names and

Employer Identification

Numbers (EIN) you have

used in the last 8 years

 I have not used any business name or EINs.

DBA Chicago Chiropractic Clinic

 I have not used any business name or EINs.

Include trade names and

doing business as names

Business name(s) Business name(s)

EINs EINs

5. Where you live If Debtor 2 lives at a different address:

800 N. Michigan Avenue

Unit 2203

Chicago, IL 60611-2150

Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code

Cook

County County

If your mailing address is different from the one

above, fill it in here. Note that the court will send any

notices to you at this mailing address.

If Debtor 2's mailing address is different from yours, fill it

in here. Note that the court will send any notices to this

mailing address.

Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, City, State & ZIP Code

6. Why you are choosing

this district to file for

bankruptcy

Check one:

 Over the last 180 days before filing this petition,

I have lived in this district longer than in any

other district.

 I have another reason.

Explain. (See 28 U.S.C. § 1408.)

Check one:

 Over the last 180 days before filing this petition, I

have lived in this district longer than in any other

district.

 I have another reason.

Explain. (See 28 U.S.C. § 1408.)

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3

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Debtor 1 Shawni S. Moshiri Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the

Bankruptcy Code you are

choosing to file under

Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy

(Form 2010)). Also, go to the top of page 1 and check the appropriate box.

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

8. How you will pay the fee  I will pay the entire fee when I file my petition. Please check with the clerk’s office in your local court for more details

about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashier’s check, or money

order. If your attorney is submitting your payment on your behalf, your attorney may pay with a credit card or check with

a pre-printed address.

 I need to pay the fee in installments. If you choose this option, sign and attach the Application for Individuals to Pay

The Filing Fee in Installments (Official Form 103A).

 I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may,

but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line that

applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must fill out

the Application to Have the Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.

9. Have you filed for

bankruptcy within the

last 8 years?

 No.

 Yes.

District

Northern District of

Illinois (Chicago) When 11/25/15 Case number 15-40191

District

Northern District of

Illinois (Chicago) When 7/30/14 Case number 14-27900

District When Case number

10. Are any bankruptcy

cases pending or being

filed by a spouse who is

not filing this case with

you, or by a business

partner, or by an

affiliate?

 No

 Yes.

Debtor Relationship to you

District When Case number, if known

Debtor Relationship to you

District When Case number, if known

11. Do you rent your

residence?

 No. Go to line 12.

 Yes. Has your landlord obtained an eviction judgment against you and do you want to stay in your residence?

 No. Go to line 12.

 Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it with this

bankruptcy petition.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4

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Debtor 1 Shawni S. Moshiri Case number (if known)

Part 3: Report About Any Businesses You Own as a Sole Proprietor

12. Are you a sole proprietor

of any full- or part-time

business?

 No. Go to Part 4.

 Yes. Name and location of business

A sole proprietorship is a

business you operate as

an individual, and is not a

separate legal entity such

as a corporation,

partnership, or LLC.

Name of business, if any

If you have more than one

sole proprietorship, use a

separate sheet and attach

it to this petition.

Number, Street, City, State & ZIP Code

Check the appropriate box to describe your business:

 Health Care Business (as defined in 11 U.S.C. § 101(27A))

 Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

 Stockbroker (as defined in 11 U.S.C. § 101(53A))

 Commodity Broker (as defined in 11 U.S.C. § 101(6))

 None of the above

13. Are you filing under

Chapter 11 of the

Bankruptcy Code and are

you a small business

debtor?

If you are filing under Chapter 11, the court must know whether you are a small business debtor so that it can set appropriate

deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of

operations, cash-flow statement, and federal income tax return or if any of these documents do not exist, follow the procedure

in 11 U.S.C. 1116(1)(B).

For a definition of small

business debtor, see 11

U.S.C. § 101(51D).

 No. I am not filing under Chapter 11.

 No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the Bankruptcy

Code.

 Yes. I am filing under Chapter 11 and I am a small business debtor according to the definition in the Bankruptcy Code.

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any

property that poses or is

alleged to pose a threat

of imminent and

identifiable hazard to

public health or safety?

Or do you own any

property that needs

immediate attention?

 No.

 Yes.

What is the hazard?

If immediate attention is

needed, why is it needed?

For example, do you own

perishable goods, or

livestock that must be fed,

or a building that needs

urgent repairs?

Where is the property?

Number, Street, City, State & Zip Code

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5

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Debtor 1 Shawni S. Moshiri Case number (if known)

Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

15. Tell the court whether

you have received a

briefing about credit

counseling.

The law requires that you

receive a briefing about

credit counseling before

you file for bankruptcy.

You must truthfully check

one of the following

choices. If you cannot do

so, you are not eligible to

file.

If you file anyway, the court

can dismiss your case, you

will lose whatever filing fee

you paid, and your

creditors can begin

collection activities again.

You must check one: You must check one:

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a

certificate of completion.

Attach a copy of the certificate and the payment

plan, if any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, and I received a certificate of

completion.

Attach a copy of the certificate and the payment plan, if

any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have

a certificate of completion.

Within 14 days after you file this bankruptcy

petition, you MUST file a copy of the certificate and

payment plan, if any.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, but I do not have a certificate

of completion.

Within 14 days after you file this bankruptcy petition, you

MUST file a copy of the certificate and payment plan, if

any.

 I certify that I asked for credit counseling

services from an approved agency, but was

unable to obtain those services during the 7

days after I made my request, and exigent

circumstances merit a 30-day temporary waiver

of the requirement.

To ask for a 30-day temporary waiver of the

requirement, attach a separate sheet explaining

what efforts you made to obtain the briefing, why

you were unable to obtain it before you filed for

bankruptcy, and what exigent circumstances

required you to file this case.

Your case may be dismissed if the court is

dissatisfied with your reasons for not receiving a

briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must

still receive a briefing within 30 days after you file.

You must file a certificate from the approved

agency, along with a copy of the payment plan you

developed, if any. If you do not do so, your case

may be dismissed.

Any extension of the 30-day deadline is granted

only for cause and is limited to a maximum of 15

days.

 I certify that I asked for credit counseling services

from an approved agency, but was unable to obtain

those services during the 7 days after I made my

request, and exigent circumstances merit a 30-day

temporary waiver of the requirement.

To ask for a 30-day temporary waiver of the requirement,

attach a separate sheet explaining what efforts you made

to obtain the briefing, why you were unable to obtain it

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

If the court is satisfied with your reasons, you must still

receive a briefing within 30 days after you file. You must

file a certificate from the approved agency, along with a

copy of the payment plan you developed, if any. If you do

not do so, your case may be dismissed.

Any extension of the 30-day deadline is granted only for

cause and is limited to a maximum of 15 days.

 I am not required to receive a briefing about

credit counseling because of:

 I am not required to receive a briefing about credit

counseling because of:

 Incapacity.

I have a mental illness or a mental deficiency

that makes me incapable of realizing or

making rational decisions about finances.

 Incapacity.

I have a mental illness or a mental deficiency that

makes me incapable of realizing or making rational

decisions about finances.

 Disability.

My physical disability causes me to be

unable to participate in a briefing in person,

by phone, or through the internet, even after I

reasonably tried to do so.

 Disability.

My physical disability causes me to be unable to

participate in a briefing in person, by phone, or

through the internet, even after I reasonably tried to

do so.

 Active duty.

I am currently on active military duty in a

military combat zone.

 Active duty.

I am currently on active military duty in a military

combat zone.

If you believe you are not required to receive a

briefing about credit counseling, you must file a

motion for waiver credit counseling with the court.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 6

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Debtor 1 Shawni S. Moshiri Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do

you have?

16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by an

individual primarily for a personal, family, or household purpose.”

 No. Go to line 16b.

 Yes. Go to line 17.

16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain

money for a business or investment or through the operation of the business or investment.

 No. Go to line 16c.

 Yes. Go to line 17.

16c. State the type of debts you owe that are not consumer debts or business debts

17. Are you filing under

Chapter 7?

 No. I am not filing under Chapter 7. Go to line 18.

Do you estimate that

after any exempt

property is excluded and

administrative expenses

are paid that funds will

be available for

distribution to unsecured

creditors?

 Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative expenses

are paid that funds will be available to distribute to unsecured creditors?

 No

 Yes

18. How many Creditors do

you estimate that you

owe?

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than100,000

19. How much do you

estimate your assets to

be worth?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

 $1,000,000,001 - $10 billion

 $10,000,000,001 - $50 billion

 More than $50 billion

20. How much do you

estimate your liabilities

to be?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

 $1,000,000,001 - $10 billion

 $10,000,000,001 - $50 billion

 More than $50 billion

Part 7: Sign Below

For you I have examined this petition, and I declare under penalty of perjury that the information provided is true and correct.

If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13 of title 11,

United States Code. I understand the relief available under each chapter, and I choose to proceed under Chapter 7.

If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out this

document, I have obtained and read the notice required by 11 U.S.C. § 342(b).

I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.

I understand making a false statement, concealing property, or obtaining money or property by fraud in connection with a

bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519,

and 3571.

/s/ Shawni S. Moshiri

Shawni S. Moshiri Signature of Debtor 2

Signature of Debtor 1

Executed on July 31, 2016 Executed on

MM / DD / YYYY MM / DD / YYYY

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 7

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Debtor 1 Shawni S. Moshiri Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by

an attorney, you do not need

to file this page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to proceed

under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each chapter

for which the person is eligible. I also certify that I have delivered to the debtor(s) the notice required by 11 U.S.C. § 342(b)

and, in a case in which § 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry that the information in the

schedules filed with the petition is incorrect.

/s/ J. Kevin Benjamin ARDC #: Date July 31, 2016

Signature of Attorney for Debtor MM / DD / YYYY

J. Kevin Benjamin ARDC #:

Printed name

Benjamin | Brand | LLP

Firm name

1016 W. Jackson Boulevard

Chicago, IL 60607-2914

Number, Street, City, State & ZIP Code

Contact phone (312) 853-3100 Email address attorneys@benjaminlaw.com

6202321

Bar number & State

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8

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 Document Page 8 of 16
}bk1{Credito AresMatix}bk{

63rd & Pulaski Property Group, LLC

3918 W. 63rd Street

Chicago, IL 60629-4604

63rd Laser & Skin Clinic, LLC

Attn: Nozar Amiran, A Manager

450 S. Warren Avenue

Palatine, IL 60074-6408

63rd Laser & Skin Clinic, LLC

Attn: Amin Mashouf, A Manager

800 N. Michigan Avenue, #2203

Chicago, IL 60611

800 N. Michigan Condo Association

800 N. Michigan Avenue

Chicago, IL 60611

Alloy Financial

POB 674

Minneapolis, MN 55440-0674

Ally Financial

PO Box 130424

Saint Paul, MN 55113-0004

Ally Financial

200 Renaissance Ctr

Detroit, MI 48243

Ally Financial

Po Box 380901

Minneapolis, MN 55438

Amalgamated Bank

1 West Monroe

Chicago, IL 60603

American Access Casualty

c/o James P. Newman & Associates

2570 FoxField, #201

Saint Charles, IL 60174

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American Chartered Bank

932 W. Randolph Street

Chicago, IL 60607

Amin Mashouf

800 N. Michigan Avenue

Unit 2203

Andrew Everest, Esq.

The Everest Firm

2035 W. Charleston, Suite 305

Chicago, IL 60647

Anesthesia 123 PC

c/o Law office of David B. Sosin

11800 S. 75th Avenue, Suite 300

Palos Heights, IL 60463

AUSA-Chicago

U.S. Attorneys Office- NDIL-Chicago

219 S. Dearborn Street, Suite 500

Chicago, IL 60604

BMW Bank of North America

5550 Britton Parkway

Hilliard, OH 43026

BMW Bank of North America Dept.

c/o/Ascension Capital Group

PO Box 201347

Arlington, TX 76006

Brian S. Wallach, Esq.

U.S. Attorneys Office -NDIL-Chicago

219 S. Dearborn Street, 5th Floor

Chicago, IL 60604

Broadway Tiffany, LLC.

c/o Vedder Price, PC.

222 N. LaSalle Street, #2400

Chicago, IL 60601

Capital One

Attn: Bankruptcy

Po Box 30285

Salt Lake City, UT 84130

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Capital One

Pob 30281

Salt Lake City, UT 84130

Carl Peter Clavelli, Esq.

53 W. Jackson Boulevard

Suite 733

Chicago, IL 60604

Carlos G. Baldoceda, MD

3412 W. Fullerton Avenue

Chicago, IL 60647-2416

Chicago Foot Clinic, Ltd.

Attn: Jeffrey A. Zaluda, Reg Agent

500 W. Madison Street, Suite 3700

Chicago, IL 60661

Citibank

Citicorp Credt Srvs/Centralized BK

Po Box 790040

Saint Louis, MO 63179

Citibank

Po Box 6241

Sioux Falls, SD 57117

Citibank So Dak NA

c/o Blatt Hasenmiller Leibsker & Mo

10 S. LaSalle Street, Suite 2200

Chicago, IL 60603

Codilis & Associates, P.C.

15W030 North Frontage Road

Suite 100

Burr Ridge, IL 60527

Consumers Coop Cred Un

Po Box 9119

Waukegan, IL 60079

Consumers Coop Cred Un

2750 Washington St

Waukegan, IL 60085

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Diane MacArthur, Esq.

U.S. Attorneys Office -NDIL-Chicago

219 S. Dearborn Street, 5th Floor

Chicago, IL 60604

Dr. Louis Carrozza

3918 W. 63rd Chicago

Chicago, IL 60629

FirstMerit Bank

7227 W. Addison Street

Chicago, IL 60634

Freedman, Anselmo, Lindberg

1771 W. Diehl

Suite 150

Naperville, IL 60566

Illinois Department of Revenue

Bankruptcy Section

POB 64338

Chicago, IL 60664-0338

Internal Revenue Service

Centralized Insolvency Operation

PO Box 7346

Philadelphia, PA 19101-7346

Internal Revenue Service

Centralized Insolvency Operation

POB 7317

Philadelphia, PA 19101-7317

Joel F. Handler

1 E. Wacker Drive

Suite 510

Chicago, IL 60601

Joel M. Hammerman

U.S. Attorneys Office (NDIL)

219 S. Dearborn Street, Suite 500

Chicago, IL 60604

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Kelly Mattea Greening, Esq.

U.S. Attorneys Office -NDIL-Chicago

219 S. Dearborn Street, 5th Floor

Chicago, IL 60604

Lee A. Hendricks

c/o Joseph R. Curcio, Esq.

161 N. Clark Street, Suite 2240

Chicago, IL 60601

Levenfeld Pearlstein, LLC

2 N. LaSalle Street

Suite 1300

Chicago, IL 60602

Lexington Circuit Court

139 Main Street

Lexington, SC 29072

Marvin A. Brustin Ltd.

10 N. Dearborn Street

7th Floor

Chicago, IL 60602

Midway Cosmetic Institute, LLC

c/o Amin Mashouf, as A Mgr & Reg Ag

1620 S. Michigan Avenue, Unit 512

Chicago, IL 60616

Midway Cosmetic Institute, LLC

c/o Nozar Amiran, as A Manager

2138 S. Indian Avenue, Unit 1304

Chicago, IL 60616

Midwest Bank & Trust Company

1545 Ellinwood Avenue

Des Plaines, IL 60016

Mohammad R. Baniassadi, Esq.

180 N. LaSalle Street

Suite 1921

Chicago, IL 60601

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Moshiri Investment Company, LLC

c/o Jeffrey A. Zaluda, Reg Agent

500 W. Madison Street, # 3700

Chicago, IL 60661

Moshiri Real Estate, LLC

c/o Jeffrey A. Zaluda, Reg Agent

500 W. Madison Street, #3700

Chicago, IL 60601

Much Shelist Deneberg

191 N. Wacker Drive

Suite 1800

Chicago, IL 60606

Navient Solutions, Inc.

Attn: Claims Processing

P.O. Box 9500

Wilks-Barr, PA 18773-9500

Navient Solutions, Inc., c/o MHEAC

d/b/a American Student Assistance

100 Cambridge Street, #1600

Boston, MA 02114

Net Bank Business Finance

100 Executive Center Drive

Suite 101

Cranston, RI 02921

Presence Health

62392 Collection Ceneter Drive

Chicago, IL 60693

Provident Bank

114 E. Lexington Street

Baltimore, MD 21202-1703

Republic Bank of Chicago

1510 75th Street

Darien, IL 60561-3766

Ronald R. Peterson

Jenner & Block, LLP

353 N. Clark Street

Chicago, IL 60654

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Ryan S. Hedges, Esq.

Vedder Price, P.C.

222 North LaSalle Street, Suite 260

Chicago, IL 60601

Saul Lopez

6737 W Belmont Ave

Chicago, IL 60634-4648

Shawni Moshiri

601 W. Randolph Street

Chicago, IL 60601

Shiva Moshiri

800 N. Michigan Avenue

Suite 2203

Chicago, IL 60611

Terra Reynolds

U.S. Attorneys Office (NDIL)

219 S. Dearborn Street, Suite 500

Chicago, IL 60604

The Private Bank And Trust Company

149 E. Walton Place

Chicago, IL 60611

The Private Bank And Trust Company

70 W. Madison Street

Chicago, IL 60602

TIffany Broadway, LLC

c/o Joel Handler

1 E. Wacker Drive, Suite 510

Chicago, IL 60601

Tom Makendonski

Law Office of Tom Makedonski

7354 N. Milwuakee

Niles, IL 60714

Tony Faham

c/o Law Office of Joel F. Handler

55 W. Wacker Drive

Chicago, IL 60601

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United States Attorney

Criminal Department

219 S. Dearborn Street

Chicago, IL 60604

United States Attorney Criminal Div

219 S. Dearborn Street

Chicago, IL 60604

US Bank

PO Box 6335

Fargo, ND 58125-6335

VCE Enterprises

PO Box 83

Rockland, MA 02370-0083

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